Proposal to distribute potassium iodide

A Proposal to Stockpile and Distribute Potassium Iodide

BACKGROUND
Considerable evidence exists to support the claim that potassium iodide (KI) is a safe and highly effective thyroid blocking agent for use in the event of the release of radioactive iodine from a nuclear weapon or nuclear reactor (find nuclear reactor near you). If administered prior to radiation exposure, potassium iodide will saturate the thyroid with “cold” (i.e., stable, non-radioactive) iodine, “filling it up,” and thus preventing the absorption of radioactive iodine which can cause a highly aggressive form of thyroid cancer.

Though reactors and bombs produce numerous radioactive by-products, radioactive iodine is, by far, the most dangerous to the largest number of people. If released, it can take the form of an aerosol cloud which can travel hundreds of miles downwind from its origin, threatening literally millions of people in its unpredictable wind blown path. Its toxicity can still be seen today in Japan where (more than 60 years after Hiroshima) nearly half (45%) of the population suffers thyroid damage due to the bombings.

The Chernobyl accident may have been worse. According to United Nations and World Health Organization research, the release of radiation from the Chernobyl reactor blew across Europe, and has led to over 11,000 known thyroid cancers; some documented as far as 500 km from the release. No other radio-product had a similar effect, with the US Nuclear Regulatory Commission (NRC) reporting “apart from thyroid cancer, there has been no confirmed increase in the rates of other cancers including leukemia.”

There was only a small amount of potassium iodide at Chernobyl, but where it was available, it worked. The NRC has reported that among those who received it, “thousands of measurements” demonstrated that “the use of potassium iodide by the Pripyat population was credited with permissible iodine content (less than 30 rad) found in 97% of the 206 evacuees tested at one relocation center.” But outside of Pripyat where potassium iodide was not available, thyroid damage among individuals exposed to the radiation is epidemic today.

But potassium iodide has one major limitation. To be of value, it must be taken prior to (or within 8 hours of) exposure. That’s why the Soviets were unable to produce more and ship it into the affected areas. There simply was not enough time. What Chernobyl showed is that potassium iodide must be in stockpiles prior to a release, or thousands will suffer unnecessary cancer. (Steps taken in Poland proved this. Within six days of the Chernobyl release, the Polish government distributed potassium iodide to 17 million people. Today Poland, alone among the countries in the region, has no cancers attributable to Chernobyl.)

HOW MUCH POTASSIUM IODIDE IS NEEDED?
This is not an easy question to answer. FDA guidelines call for the daily administration of potassium iodide (one tablet per day) “for as long as the threat continues.” But the duration of the threat is dependent upon the size of the release and one’s proximity to the release point. The release point, of course, could be any of the nation’s 103 commercial reactors, or any industrial, research or educational (university) reactor, or just any large or mid-sized US city (which could be a terrorist target) Consequently, there is no way to know, before a release occurs, how much potassium iodide to stockpile or where it might be needed.

Because the amount of radioactive iodine in the environment decreases as one travels away from the release point, and because radioactive iodine has an 8.1 day “half-life” (requiring about 60 days to fall below one percent of the original release), we believe that the minimum amount of potassium iodide for an individual remaining in a contaminated location should be in general accordance with the following table:

Distance From Release Point Number of Tablets Required
_____________________________________________________ ________________________________________________

0 to 50 miles 60 tablets 50 to 100 miles 40 to 60 tablets 100 to 200 miles 20 to 60 tablets Over 200 miles 6 tablets (if exposure indicated)

The inability to know how much potassium iodide could be needed (and where to put it) suggests that the most effective and least expensive method for radiation protection would be a two-stage storage and distribution program which would (1) include short term emergency supplies for everyone (stored locally in government facilities or pre-distributed to people in the immediate vicinity of nuclear plants), and (2) would incorporate a mechanism to quickly move additional potassium iodide into affected areas (for long-term protection) from distant stockpiles located outside the affected areas. Given the likelihood of considerable confusion in an emergency, and because potassium iodide must be taken daily, we believe it would be prudent to assume 6 days—and 6 potassium iodide tablets per person—would be required for the short-term supplies and to allow time to move and distribute supplemental tablets into contaminated areas.

WHERE SHOULD THE STOCKPILES BE LOCATED?

Because no place in the United States is beyond risk, tablets need to be stocked in locations around the country in sites from which they can be easily and promptly locally distributed in an emergency. Thousands of sites are needed, and each site must:

A) Have equipment and trained personnel with in-depth knowledge of the local area, and established routes for prompt distribution of tablets to all households in the community
B) Be operated by federal government employees accustomed to warehousing and delivering items of value. Have a facility with a well-known location which is capable of handling a large volume of traffic
C) Be prepared and able to quickly ship tablets from one stockpile location to another, since the plan requires that areas unaffected by a nuclear release immediately ship their supplies of tablets into areas that are affected—where additional potassium iodide tablets would be needed for long-term protection

The infrastructure that meets these requirements already exists and is ideal for the warehousing and distribution of potassium iodide. It is, of course, the US Postal Service (USPS), with thousands of local offices, trained personal and equipment suited for potassium iodide delivery, knowledge of residential locations, and a demonstrated ability to move a large quantity of items between USPS offices.

According to one source, a typical post office reaches 95 to 97% of the houses in its coverage area in about 6 hours, and does so almost every day. Since a six unit package of IOSAT™ easily fits into a standard letter envelope, it could be handled and delivered with no special equipment. Further, since IOSAT is so light and compact, a million blister-packed tablets can fit on a single 4 X 4 pallet which can be stored in virtually any dry environment.

DISTRIBUTION PLAN

As noted, the potassium iodide stockpile plan calls for establishing nationwide “short-term” supplies of six tablets for immediate protection, with long-term protection provided by moving tablets into affected areas from locations outside the contaminated zone.

Since every radiological emergency would probably be unique, the ability of officials to respond flexibly to incident needs is key. However, general guidelines for response and distribution would be as follows:

Precursor of an Emergency
In the event of signs of an emergency with a potential release from a nuclear power plant, or should detonation of a nuclear weapon be suspected, distribution of potassium iodide would begin to individuals living within 15 miles of the release point with instructions to begin administration of potassium iodide immediately (one tablet per day). Should subsequent events indicate no release has occurred, those with tablets will be told to stop taking them. However, if the possibility of a radiation emergency increases, all persons within 15 miles who can evacuate would be advised to do so. To calm fears, announcements via TV would reassure the public that authorities are taking steps which will assure their safety.

Confirmation of a Release and Stage One Distribution
Once a release has been confirmed, officials would have the flexibility to order potassium iodide distribution (six tablets) to everyone within 50 miles of the release from the local postal stockpiles. People beyond 15 miles would be urged to remain indoors and to follow government instructions, but evacuation beyond 15 miles would NOT be encouraged (except for high risk populations, such as pregnant women and children) in order to prevent massive gridlock which would impair emergency response efforts. At this point, probably nothing would be more important than for potassium iodide distribution to be well publicized and highly visible, so as to demonstrate to the public that the government is in control, and has a well thought-out plan to provide civilian protection. Efforts to destroy possibly contaminated food would begin. In order to obtain additional potassium iodide, orders would be issued to ship potassium iodide stockpiled in post offices more than 1000 miles away, to post offices within the potentially affected areas (cities and towns within 200 miles of the release).

Severe Release and Stage Two Distribution
If a release is known to be severe and capable of endangering people at a significant distance from the release point, authorities would have the flexibility to order additional distributions as necessary (using the new supplies received) for up to 200 miles from the release. Government announcements would continue to urge people to remain calm and to be confident that adequate supplies of potassium iodide are available. Evacuation would be actively discouraged except for the most vulnerable (infants and pregnant women).

FEASIBILITY

This plan assumes that the NRC reactor-design philosophy of “leak before break” can be counted on to provide time (up to two or more days) for short-term potassium iodide distribution before a release occurs, and that six days will be enough to accumulate and distribute the additional tablets needed for long-term protection (for those who cannot, or will not, evacuate). This plan further assumes that outside the immediate release area there would be no disruptions in basic government services that would impact the plan’s feasibility. As long as there is no general order to evacuate (that is, beyond 15 miles), it is expected that police and fire stations will operate, mail will be delivered, television and telephones will work, etc.

The feasibility of this plan, and its assumption that postal distribution could take place in an emergency, is not without precedent. As far as can be ascertained, life went on as usual beyond a few miles from Three Mile Island during the 1979 accident there, and although there was public anxiety, there were no major disruptions of basic services. Consequently, we believe that while potassium iodide distribution right near the reactor could be spotty, once beyond 10 to 15 miles (where the vast majority of people are located) postal delivery would be reasonably effective at smoothly distributing tablets to millions of people.

COST

IOSAT Potassium Iodide is inexpensive. In volume, the annual cost to protect every American would be pennies per individual. But the financial impact of a radiation emergency would be enormous. A nuclear accident on the scope of Chernobyl could cause 15,000 to 50,000 cases of thyroid cancer (or more, if a reactor release or a terrorist attack, took place in a heavily populated area such as New York or Washington). Further, probably 3 to 10 times this number of people would suffer other thyroid problems, such as nodules or hypothyroidism. Medical costs to treat these injuries would be staggering, and the cost in human suffering (especially among children) would be incalculable.

(Some idea of the cost of a nuclear accident was presented in an April 2006 study by the International Atomic Energy Agency (IAEA), who found that, in Belarus, “government spending on Chernobyl amounted to 22.3 percent of the national budget in 1991.” The Report also found that “In Ukraine, 5-7 percent of government spending each year is still devoted to Chernobyl-related benefits and programmes.” The cost of a terrorist incident could be similar.)

Worse would be the psychological toll. Because the development of cancer will take 3 to 20 years, and because no one would know if they had received a dose of radiation sufficient to cause cancer in the future, any unprotected person would worry about their health for many years after the incident. This has been observed among Chernobyl survivors, who today blame the accident for virtually every ailment they suffer and (based on anecdotal evidence) expect things to get worse. But it’s a self-fulfilling prophecy. Widespread anxiety over the unknown health consequences of radiation has led to significant stress among the entire population (which the IAEA report calls “a paralyzing fatalism”), which has led to a consequent general deterioration of the health of the entire society. The enormous cost of this can not even be estimated. Clearly, if people were convinced that the small pills given to them by the government would protect them, much of the psychological “costs” of a radiation emergency could be avoided.

CONCLUSION

While the chances of a nuclear emergency are unclear, world events make it impossible to deny the realistic potential for one to occur. Unfortunately, the odds are uncomfortably high. Estimates, for example, originating from experts at the NRC (who, despite previous accidents and near misses, tend to be optimistic about nuclear safety) have suggested a 50% chance of an accident in any twenty-year period. And while no one can judge the likelihood of a terrorist attack or hostile nuclear action by a state (Iran or North Korea, for example), the threat of this occurring can certainly not be ignored. Indeed, the cliché—“not if, but when”—is all-too frequently heard.

Given this reality, responsible public officials have the obligation to explore the value of potassium iodide, and to implement measures to minimize thyroid damage in a nuclear emergency. This responsibility should be neither questionable nor controversial. The 2002 Bio-Terrorism Act has already mandated potassium iodide stockpiling around nuclear power plants, and the FDA, the US National Academy of Sciences, the American Thyroid Association, the American Academy of Pediatrics, and numerous others have all urged the drug’s availability. Even funding is in place through Project Bioshield. What is needed today is to decide how much potassium iodide to stockpile, where to store it, and Guidelines for its distribution. Yet, to date, our government has done almost nothing, acquiring only enough potassium iodide (so far) for about one percent of the population, and refusing to prepare an emergency potassium iodide response plan for the remaining 99%. Instead, current response programs largely ignore potassium iodide, and depend upon futile attempts to evacuate millions of people—despite evidence that this response measure could not work—and would undoubtedly make things worse by clogging roads and increasing radiation exposure among people sitting for hours in traffic.

No one disputes that potassium iodide is an inexpensive highly effective method to add a significant level of safety in a dangerous world. To ignore the warnings of experts and the experience at Chernobyl cannot be justified. One can only wonder what explanation government officials would give if tens of thousands of Americans developed avoidable cancers because no one had acted.

– Anbex, Inc.

REFERENCES

1. American Academy of Pediatrics, News Release. May 10, 2003 noting that potassium iodide is “100% effective.”
2. American Journal of Medicine: Iodine Prophylaxis in Poland After the Chernobyl Accident (May 1993).
3. American Thyroid Association. Letter from Dr. David Becker to USNRC of February 13, 1998.
4. American Thyroid Association. Letter from Martin Surks, MD to USNRC of January 9, 1998.
5. Federal Register, December 15, 1978.
6. FDA Talk Paper, December 10, 2001.
7. FDA Guidance: Potassium Iodide as a Thyroid Blocking Agent in Radiation Emergencies (Dec. 2000).
8. National Council on Radiation Protection: NCRP Report Number 42.
9. National Council on Radiation Protection: NCRP Report Number 55.
10. National Research Council of the National Academies of Science: Distribution of Potassium Iodide in a Nuclear Accident. (January, 2004).
11. Pediatrics Magazine, June, 2003.
12. Public Meetings: Assessment of the Use of Potassium Iodide as a Public Protective Action (Nuclear Regulatory Commission Task Force) December 1, 1998 and March 15, 1999.
13. Report of the President’s Commission on the Accident at Three Mile Island John J. Kemeny, Chairman Notes that at the time of the accident, when almost no potassium iodide was available, the decision was made to withhold it from everyone (including the emergency workers at the plant) in order to keep its existence secret. The fear was that the possibility of rioting by those trying to get potassium iodide might be worse than the accident itself.
14. Symposium on Health Aspects of Nuclear Power Plant Incidents: Recommendations on the Use of Potassium Iodide: An FDA Update (April 1983) which finds that there are “not sufficient grounds from which to conclude, or even to suggest a significant proportion of serious [side] reactions” from the drug.
15. United Nations Office for Humanitarian Affairs (OCHA). Chernobyl A continuing Catastrophe 2000 which notes that over 11,000 children have contracted thyroid cancer from Chernobyl, through 2000.
16. U.S. Nuclear Regulatory Commission. Office of Public Affairs News Release 11/30/01.
17 U.S. Nuclear Regulatory Commission and Sandia National Labs., Examination of the Use of Potassium Iodide (potassium iodide) as an Emergency Protective Measure for Nuclear Reactor Accidents, NUREG/CR-1433, Oct., 1980). Note that this document indicates that an exposed child 50 miles from the release point would have more than a 1 in 4 chance of suffering thyroid damage, even where contaminated food and water had been prevented from entering the area.
18. U.S. Nuclear Regulatory Commission, Assessment of the Use of Potassium Iodide (potassium iodide) As a Public Protective Action During Severe Reactor Accidents, Draft Report for Comment, NUREG-1633. Note that this document presents a chart showing that 97% of the first 750 cases of thyroid cancer in Belarus due to Chernobyl took place from 30, to over 200, miles from the damaged reactor. Similar findings have been presented by the World Health Organization and expressed by the US Food and Drug Administration.
19. World Health Organization: Guidelines for Iodine Prophylaxis following Nuclear Accidents. (1999 Update) Note that the World Health Organization is unequivocal regarding expanded potassium iodide distribution, stating that “the Chernobyl accident has thus demonstrated that significant doses of radioactive iodine can occur hundreds of kilometers from the site, beyond emergency planning zones.”
20. www.cdc.gov
21. www.fda.gov
22. International Atomic Energy Agency. Chernobyl’s Legacy: Health, Environmental and Socio-economic Impacts, The Chernobyl Forum, 2003-2005. Released April, 2006.
23. Journal of the American Medical Association, Thyroid Disease 60 Years After Hiroshima and 20 Years After Chernobyl. JAMA, March 1, 2006-Vol. 295, No. 9. American Medical Association